Geriatric Services

Introduction
The population is gradually aging
In India, 5% population is above the age of 60

years
In Western countries this is more than double

In 2006 World Population Prospects a report

by the Population Division of the UN Department of Economic and Social Affairs projects the following:

Introduction
By 2050, Indias life expectancy is likely to increase

from the current 64.7 to 75.6 years

Indians above 80 will increase more than six times

from the current 78 lakh

People over 65 will almost quadruple from 6.4 crore

in 2005 to 23.9 crore

Population aged 15-24 years will decrease from

present 19.3% to 12.7%

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Aging of Population
By aging of population is meant the increase in

the proportion of people in the higher age group of population

Causes
Decrease in fertility Reduced mortality Migration of people

High-Risk Group Amongst Elderly

Very old people

Aged person living alone

Aged women, especially single and widowed Aged people living in institutions Isolated old people Aged people suffering from severe ailments or

handicaps Aged couple in which one spouse is seriously ill or handicapped Aged people having to live on the minimum support provided by the state or social security, or on even less
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Geriatrics Terminology
Aging of the Population
Denotes a physiologic process that begins at

conception and entails changes, characteristic for the species, throughout the whole life cycle
Gerentology
Defined as the scientific approach to all aspects of

aging (health, sociological, economic, environmental and others) It is, most often a multidisciplinary field

Geriatrics
It is a branch of gerontology and medicine that is

concerned with the health of the elderly in all its aspects:

Preventive Clinical

Remedial
Rehabilitation Continuous surveillance

Geriatric Problems
Health Fundamentally, it does not differ from other health problems But the special features are:
Ill health in elderly is manifested by a number of physical or mental

defects These were either neglected in earlier part of life or that occurred later

Morbidity Pattern is usually of degenerative nature Most prevalent are:

Cardiovascular Cerebrovascular Cancer Diseases of locomotor system Mental illness Diseases of vision and hearing Accidents

Geriatric Problems
Mortality
11.9% over 60 years

Fatal illness
Cardiovascular 23% Cerebrovascular

Respiratory
Renal Failure Others

23.1% 10.8% 34.5%

4.1%

Geriatric Problems
Mortality Increases in the older age group Leading causes above 65 years are:
Cardiovascular diseases Cerebrovascular accidents Malignant diseases

Early detection There is no comprehensive programme or system for detecting ill health that is not readily apparent Physical, mental, environmental, or social factors causing ill health often go unreported This specially affects the health of the elderly

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Geriatric Problems
Nutrition Elderly people are often subclinically malnourished Oral health Good oral hygiene favours correct nutrition Has positive psychological and social effects May prevent disease Environment Both physical and social environment have important bearing on the health of elderly Socioeconomic factors

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Hospitalization Data
New Delhi Hospital)

(From a

Male : Female 2:1 (N = 3142) Types of patients Medical 47.2% Eye 19.4% Surgical 15.1% Orthopaedics 4.5% Medical Cardiac 33.7% Respiratory 31.6% Neurological 19.2% Gastrointestinal 5.6% Renal 3.6% ALS 9 days for patients over 60 years
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Concepts and Principles for Geriatric Services

Essentially a community service Doctors, Public health nurse, Social service agencies,
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Hospital - all take part Best place for elderly is their own home Aged are at-risk population Main emphasis on prevention A holistic approach Geriatric service as part of general health service Service oriented towards family and community Spectrum of service wide Service available to all Continuous evaluation

Geriatric Service Concepts and Principles

Geriatric service should be a part of the general health

service
Service should be oriented to the family and community

with integration and coordination

Spectrum of service should be wide with concept of

progressive patient care with continuity of service Service should be available to all
A continuous evaluation mechanism should be built into

the system

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The Aims
Sustained in Independence, Comfort and

Contentment in home surrounding

Those in need should be provided with alternative

residential accommodation
Hospital accommodation to be provided to those in

need of full medical assessment, therapy, rehabilitation or long term skilled medical or nursing care

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Components
A model geriatric programme comprises the

following elements:
General practitioners health centre Domiciliary service Hospital services and

Community services

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Health Centers (Model Proposed by

WHO)
8-12 GPs serve 20,000 to 30,000 people Domiciliary, community services can be

integrated
Entire health team meet at the centre Team includes physician, social worker, nurses

and voluntary agencies

Screening done by nurse
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Domiciliary Service
Service includes: (in patients own home)
Home helpers Night sitters-in Meals on wheels

Physiotherapy
Occupational therapy Chiropody

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Hospital Services
A Geriatric Unit OPD Day Hospital Continuing treatment
Long term beds including Terminal care
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Bed Distribution
ICU -2-5% Semi-intensive and basic care 50-55% Long stay 15% Neuropsychiatry 10-12% Rehabilitation 15%

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Changes Associated with Aging

Vision Glaucoma, cataracts, macular degeneration Sensitivity to glare Reduced speed of accommodation to changing light levels Reduced vision in low light Yellowing of the aging lens Reduced visual acuity Reduced fields of vision

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Changes Associated with Aging

Hearing Reduced hearing ability Malfunctioning hearing aids Sensitivity to high frequency noises Difficulty filtering out background noise

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Changes Associated with Aging

Physical Changes Loss of muscle strength (up to 40% - 60%) , flexibility and coordination Reduced balance Reduced reflex /reaction time Reduced dexterity and fine motor coordination Increased response to environmental vibration Decreased thermal response (tolerance of a lower range of room temperatures)

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Changes Associated with Aging

Cognitive Function Increased prevalence of dementia with age Reduced memory Visual perception changes Reduced reasoning and abstract thinking Communication changes Increased susceptibility to delirium

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SENIOR FRIENDLY PHYSICAL ENVIRONMENT IN HOSPITALS

Lighting Seniors require 30% more light for equivalent vision, and up 5 times brighter light in areas for reading and task completion 30-70 foot-candles indoor illumination Consider using natural fluorescents ,full spectrum lights(T5 and T8 lamps) Ensure no glare
Cove lighting Direct illumination on vertical surfaces No highly polished surfaces
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SENIOR FRIENDLY HOSPITALS

Lighting (contd.) Avoid pooled lighting and shadows (sconces, table lamps) Provide night lighting in patient washrooms Ensure focused light on signs and other way finding cues Ensure consistent levels of brightness in adjacent areas Create gradual changes of light levels when coming in from outdoors
awnings or outdoor covered entranceway skylight inside entranceway brighter interior light inside entranceway
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SENIOR FRIENDLY HOSPITALS

Noise/Sound High noise levels can lead to anxiety, confusion

and fatigue from over stimulation and difficulty hearing that which is spoken to the senior. Background noise can create misinterpretations of what is happening in the environment
Reduce the use of the public address system as much

as possible and turn off in patient bedrooms Combine a visual display that scrolls slowly to inform patients in a waiting area

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SENIOR FRIENDLY HOSPITALS

Reduce background ambient noise (eg.

ventilation systems, radio) Have hearing amplifiers available in all patient contact areas Reduce the number of hard surfaces and choes Use quality acoustical ceiling and wall products consider heating and ventilation structure to reduce noise when installing

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SENIOR FRIENDLY HOSPITALS

Dcor
use colours at the warm end of

the spectrum (blue tones are difficult to see) pastels and low contrast colours are difficult to see and define use colour to define functional areas (ie yellow hallway, green rooms, amber activity room)
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SENIOR FRIENDLY HOSPITALS

use color contrast to highlight areas such as doors to

assist
Way finding.

Use the same colors on exit or out of bounds

doorways as hallways to camouflage and reduce unwanted use.

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SENIOR FRIENDLY HOSPITALS

Upholstery Avoid visual over stimulation No strongly flecked patterns Plain fabrics with mild patterns Avoid very dark colours and soft pastels Avoid "vibrational " patterns Warm colours most easily seen and appreciated

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SENIOR FRIENDLY HOSPITALS

Art Non glare finish Well lit with focused light(3-4 times brighter) Content with full spectrum colour especially in brighter tones Select pictures that are clear and realistic with definition Colour contrast to help define the features/objects in the picture Avoid the use of mirrors which may cause confusion and agitation due to visual perception changes

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SENIOR FRIENDLY HOSPITALS

Orientation/Way finding Large clocks, calendars Combine a visual display that scrolls slowly along with verbal calls to inform patients in a large waiting area Clear demarcation of different functional areas by colour, sign, physical layout, other identifying features (eg. Large distinctive picture, fish tank) Ensure patients can clearly see their destination on patient care units (ie dining room doors open, uncluttered hallways)
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SENIOR FRIENDLY HOSPITALS

Signs should be: Uncluttered with a simple message avoid too much information on one sign Strong contrast of:
Print on sign background Sign from environment background

White on dark brown or black or black on

yellow in a busy environment with white background Black on white or dark green on white for general use
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SENIOR FRIENDLY HOSPITALS

Matte, non-glare finish

Include simple explanatory graphic

Key locations (eg.bathroom) with signs

perpendicular to the wall to facilitate identification Follow CSA guidelines for signage

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Safe Mobility
Flooring Quiet cushion flooring (eg. vinyl cushion tufted) Matte, non-slip, finish or wax Low pile carpeting Even colour NO bold patterns that can create visual perception challenges Contrast baseboard or floor border to define floor edge and pathway

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Safe Mobility
Doors: All doors wide enough for easy clearance of wheelchair Threshold no more than beveled edge Lever handles Max. 8 lbs pull, 14 lbs push force Automatic door opening mechanisms for main entrances and hall doorways

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Safe Mobility
Seating area just inside entranceways to allow

vision time to adjust to light changes Adequate wheelchair availability at entranceways Accessible parking (consider valet service) Covered outside entranceway with drive-up dropoff area

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Specific Functional Areas

Bedrooms Visually distinctive doorways and bed area in shared room Direct sightline to washroom from bed Call bells Remote voice activated is ideal Ability to be fixed to bedside Large, easily activated button

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Specific Functional Areas

Telephone Black phone with large white push buttons with contrast numbers/letters Located within easy reach of bed Volume control Suitable for use with hearing aids

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Specific Functional Areas

Light switches For personal areas bedside console with clear labels and large buttons Hallways Clear, unimpeded pathways wide enough for wheelchair/walker and caregiver in each direction (larger than minimum wheelchair access standard) Avoid shiny surface with glare

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Specific Functional Areas

Avoid long hallways without visual interruption Seating areas at regular intervals along long

hallway Hand railings in hallways to assist walking (1.5daimeter with 2 hand clearance easy grip rounded style Handrails extend beyond top and bottom landings

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Specific Functional Areas

Steps use conventional (7 risers; 11treads) that will be expected highlight step edge with contrast colour (yellow) Ramps avoid if possible But if required
5% - 8% slope rest area every 30 feet mark top and bottom with yellow strip
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Specific Functional Areas

Waiting Areas Quiet small waiting areas without multiple stimuli which allow confidential conversation for the hearing impaired Combine visual and auditory cues in large waiting areas (ie. large electronic number sign to call next patient Full turning radius (as per building codes) for wheelchairs/walkers plus space for caregiver to maneuver the wheelchair in seating areas and between seats
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Specific Functional Areas

Washrooms Large enough for wheelchair/walker and caregiver access in accessible stalls in public washrooms (larger than minimum code) Patient room washrooms with full wheelchair turning radius All toilets with minimum of one non-slip grab bar 45 degree at side of toilet

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Specific Functional Areas

Accessible toilet paper dispenser (19 high, at

the side and slightly to front of toilet) with paper not hidden within dispenser High toilets(18) available in some public regular stalls Toilets in patient rooms with space for over-toilet commode

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Furniture
Tables Sturdy 4 legged Rounded corners, Edges defined with contrasting colour borders Matte tabletop Contrast table settings to assist with depth perception

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Furniture
Beds Electric adjustable height to 18 low Controller with simple technology and large easily identified buttons Pressure relieving mattress Avoid side railings that fold down to the floor Bedside tables On glides instead of wheels Lever handles for easy glide drawers
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Furniture
Chairs Seat -18-19 in. high, 18-20 in. deep with firm cushion Arms extended to front chair edge, 10 in. above seat height Lumbar support Non-slip easily cleaned fabric Clearance under front of seat to allow feet under front edge Stable/tip-free Minimal back recline and backwards seat tilt Chair legs able to be fit with blocks to further raise seat height
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OTHER FACTORS
Large print for all written materials

provided (minimum 14 font) with simple non serif characters Hearing amplifiers should be available for use with clients by ALL staff Volunteer guides to accompany seniors to their destination within a facility instead of relying on verbal directions Consider nutrition needs of seniors (diabetic, low salt food in vending machines and gift stores)
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Rehabilitation
For
Reactivation: who are passive, lethargic, and

physically and socially immobilized are encouraged to live again in his own sarrounding Resocialization: means making contact again with family, neighbours, friends, and other citizen Reintegration: Means he is again restored to the society

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Other Services
Long term care
Follow-up and after care by GP/Nurse at home

Social and Welfare Services

Restoration of pension Reduced rail fare Help age

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